Compare and contrast potential - Energy for Change Index and Hodges' model

The biopsychosocial model is quite all encompassing used as it is to help explain and represent pain, explain human development and balance the physical excesses of psychiatry.

For all its scope the biopsychosocial model is two domains short of Hodges' model.

Hodges' model is dated though, a child of the mid-1980s. The biopsychosocial model predates Hodges' and as models of nursing have fallen out of favour in terms of the attention they receive the biopsychosocial is subjected to critique as per:

Ghaemi, S.N. (2009). The rise and fall of the biopsychosocial model. Br J Psychiatry.195(1):3–4.

Hatala, A.R. (2012). The status of the “biopsychosocial” model in health psychology: Towards an integrated approach and a critique of cultural conceptions. Open Journal of Medical Psychology, 1, 51-62. doi: 10.4236/ojmp.2021.14009

A cursory check reveals a diverse and current literature on the biopsychosocial model. If this is positive for the general role of 'models' in health and social care education and learning then there is another encouraging source in the five energies for change with its five domains, as per the figure:

The five energy domains

• Spiritual
• Social
• Physical
• Psychological
• Intellectual

There is clearly great similarity with Hodges' model although in h2cm the spiritual combines all the four domains of which the political also replaces the intellectual. I would equate the intellectual with the psychological, accepting of course the existence of individual and group psychologies. Being intellectual and becoming intellectual to the extent of an individual realising their potential has long been recognised as a political matter and consequence (Freire). As such the Political domain within Hodges' model is central to its relevance within the field of engagement and innovation and beyond.

Whilst the energy for change domains have a specific derivation and (instrumental) purpose I would suggest that a possible strength for Hodges' might lie in the notion (which it is) that there is an underlying conceptual structure from which the domains arise. This structure might support the model's application in time, as well as assuring its longevity and the stamina of its champion.


My prompt: Land, M., et al. (2014) Pedal to the metal to improve the NHS. HSJ, 124, 6389, 26-27.

Image: (please see title and image link)

HCA training: Knock, knock, knocking on the political domain's door

INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

individual

emotional care	physical care
social care	FRANCIS - a year on:  How much training do healthcare assistants have before their first shift on a ward? 25% = none

group - population

Although that 25% sits nicely in the POLITICAL domain, what is the impact of this finding across the domains overall? Whether or not the impact is equally shared across the interpersonal, sciences and social domain, upon which domain will it end up knocking?

Calkin, S. (2014) Francis impacts on culture and patient safety, HSJ, 7 February. 124, 6376, 4-5.

High quality nursing care: Staff numbers + Management + Complexity = Goat (Rabbit or Duck)?

When did someone last get your goat?

For me I owe a vote of thanks to Mr Harry Cayton in the (print) Health Service Journal, 2012

 The wrong answer to the wrong question. 

I know it's hard to believe, but I've been simmering for a year and a half; especially watching, listening and reading about the NHS and the state of nursing in the media.

The subtitle of this short opinion piece (p. 16-17) reads:  

"There is no direct link between staff numbers and care quality, 

so a minimum staff ratio is a fig leaf performance measure." 

Online it is: 15 March 2012 'Mandating staffing levels is not the answer to reducing poor care'
 - so you get the gist...?

As a nurse, the subtitle did its trick, it rubbed against the whole tree of experience, not just a branch or two.

It is a long time since I was a deputy charge nurse on what was then 'psychogeriatrics'. Relatives would arrive on the ward for the first time and start to weep. We had to reassure and demonstrate that we cared not just in words, but actions: nursing care. We got things wrong: teeth, clothing. ... A variety of 'lists' and books signified institutional care. That Victorian institution is no more, this is progress. The change has been amazing. It is also a long time since I was a charge nurse on acute female admission. The thing is numbers always counted. How many times did we, the team, wonder what we could have done with another two, or four hands? Within mental health care risk is a positive and negative companion to all our patient contacts. There may be confusion in numbers, but there is safety too.

You know that numbers do count.

As Mr Cayton points out - poor management is a primary factor in poor care. He quite rightly refers to the complexity that arises. As I have posted here several times, staff attitudes and skills are central to the quality of care that follows. Mr Cayton highlights the same.

If evidence based health care is so powerful why are we still deliberating upon this?

This isn't just complex, it's complex as in complexity science. In the late 70s - 80s and even today there is discussion of dependency and workload measures. There is a real illusion at work.

As a nurse in this context you recognised the limitations of know thyself. You have to know yourself, especially: can I delegate effectively? Am I a manager's manager? How can I balance the office and the ward?

The limitation is: do I know my team? Since the 1980s I wonder how well ward managers know their team. What is the impact of agency workers - nursing and medical? How has this workforce development influenced the work and performance of the FY1s (foundation - first year doctors)?

We ensured we had covered the 'basics' as comprehensively as we could. Everyone was safe, warm, clean, skin clean and intact, dressings completed, fed, watered, given a smile, (if possible) gave a smile and as much reassurance as could be provided. Any care outstanding was reported to the next shift to ensure it was completed as a priority.

Returning to the question of evidence and the illusory, chimeric character of this debate. There is a great post-grad student essay on the relative and normative dimensions of nursing staffing to be written. Health services must wrestle with standards, local responsiveness, person-centredness, outcomes and umpteen other requirements in care delivery. If funding (staffing!) results in nurses having an arm tied behind their back, perhaps mandated staffing levels does the same for managers?

There is undoubtedly much to consider in relation to the equations that abound in staffing numbers and quality of care. As we think of trees of knowledge,  experience and branches, let's remember the leaves; everyone unique.

Update: 24 Aug 2013
News, Health Service Journal, 23 August 2013, Minimum safe staffing work yet to begin, 123, 6364, p.7. 123

"We need tools that are relevant to the care environment; we need leadership locally that has the resources and responsibility to meet the levels the tools are demanding and we need some degree of professional responsibility and decision making at ward level."
(Prof. Jim Buchan)

Additional links:

Policy Unit. Royal College of Nursing (2010) Guidance on safe nurse staffing levels in the UK
http://www.rcn.org.uk/__data/assets/pdf_file/0005/353237/003860.pdf

Safe Staffing Alliance

Kay, J. (2013). Making the case for more nurses, Health Service Journal, 123, 6355, 30-31.

Donnelly L., Mulhern, M., NHS pays £1,600 a day for nurses as agency use soars, The Telegraph, 14 Jul 2012.

http://hodges-model.blogspot.co.uk/2013/03/bbc-horizon-ii-processes-step-this-way.html

26/02/2014:
New [Lancet] study shows degree level nursing education cuts unnecessary hospital deaths
http://www.councilofdeans.org.uk/2014/02/new-study-shows-degree-level-nursing-education-cuts-unnecessary-hospital-deaths/#comment-28

"The Deprofessionals" BBC radio4: nursing, teaching and social work

Driving to Milton Keynes late afternoon for DTMD2013 Mon-Weds, I listened to a BBC radio 4 programme about the political assault on several public professions - The Deprofessionals

What does it mean to be a professional today, at a time when the public services are in a state of turmoil?
Time was when a professional was easily recognised for what he or she did by virtue of their qualifications and experience, when their competence could be measured against ...

It should be available for the next week.

When I think about community mental health nursing since 1985 I can identify with many of the points raised. How the role has changed, the former therapeutic skills focus, the change in skill mix, the advent of Agenda for Change and the existence of staff who may miss being clinically 'banded' altogether.

RFID Tags Track Possible Outbreak Pathways in the Hospital

There is no substitute for providing evidence that confirms many common-sense assumptions about what happens in the clinical environment that is the ward - in this case paediatrics.

See the links below for details and explanation.

My source: John Matson. Graphic Science. Scientific American, November 2012, page 76.
See also the original PLoS ONE paper.